Anterior-posterior Radiographs Research Articles

Technical Modifications for the Application of the Total Difference Method for Frontal Sinus Comparison.

Simple SummaryThe individuality observed in the frontal sinus cavity (located in the skull) can be used to corroborate an identification of an unknown skeleton, with a success rate that is comparable to that obtained by using dentition or DNA. For admissibility in court, however, forensic methods should be continually tested to assess their repeatability and accuracy. This study tests one technical method for obtaining the frontal sinus shape: the Total Difference Method, which quantifies the sinus shape from 59 linear measurements. We develop a more streamlined application by using a measurement aid (a tracing overlay) and a semi-automated macro to collect the multiple required measurements. The radiographs of 10 adults were assessed by two observers. The data were collected following the original method in addition to the use of a measurement aid with and without the semi-automated macro. The results indicate that this technique for assessing the frontal sinus is reliable and repeatable between and within observers, both for the original method and when using the newly developed applications. Further, the semi-automated macro improved the accuracy and efficiency over the original method. Importantly, the measurement aid will allow researchers to conduct the Total Difference Method on a larger scale, creating comparative databases that can be utilized for future forensic research and practice.Despite being used in personal identification since the 1920s, frontal sinus-based methods are rarely validated. This study is a validation test of the Total Difference Method (TDM). The posterior-anterior radiographs of 10 adults were assessed by two observers using three modes: the Freehand Mode largely followed the original protocols; the Overlay Mode utilized a tracing overlay; and the Semi-Auto Mode used the overlay and macro, walking the user through multiple steps. The modes were evaluated for the time taken to complete each image and the accuracy and repeatability of the line lengths, midline assessment, and angle placement. The repeated measures analysis of variance results for the intra-observer error revealed differences in bias in the angle placement and line length mean error between the rounds and modes. The differences between the rounds were approximately consistent for each mode, suggesting observer error. Significant differences in the inaccuracy of the angle placement and the line lengths between observers by mode were evident; in post hoc testing, the Freehand Mode and Overlay Mode had the greatest error in both variables (p.adj < 0.0001). The Semi-Auto Mode retained no significant error for angle inaccuracy and had the fewest errors for line length inaccuracy (p.adj < 0.01). When using the Semi-Auto Mode, the time was 46.1% faster than that of the Freehand Mode and 34% faster than that of the Overlay Mode (F2,18 = 52.71, p < 0.0001); time slightly improved with method familiarity. The results suggest that the technique required for the TDM can reliably be repeated, and the semi-automated macro improves accuracy and efficiency, but only after the users are familiar with the method and macro procedures. All resources needed to repeat this study are freely available on GitHub.

Mathematical modeling of indications for pelvic and proximal femurosteotomy in patients with cerebral palsy based upon clinical and radiographic parameters of the hip joint

Relevance. A differentiated approach to pelvic and proximal femur osteotomy in hip disease among patients with cerebral palsy is a relevant subject of study. The aim of the study. Diagnostic improvement in diseases of the hip joints in cerebral palsy to create a differentiated approach to the reconstruction of the pelvis and proximal femur osteotomy based upon mathematical modeling. Materials and methods. The total number of patients was 33 patients (60 joints). We conducted a clinical and radiographic examination of the hip joints using our own method and standard anterior-posterior radiographs, determining the parameters of the hip joint. Mathematical modeling of indications for proximal femur osteotomy and combination of pelvic and proximal femur osteotomy using logistic regression was also performed. A mathematical model entitled "Probability of indications for pelvic and proximal femur osteotomy " based upon acetabular angle (AA), Reimers' index (RI), GMFCS level and ambulation for both positionings was developed. We have offered a mathematical model for determining indications for pelvic and hip osteotomy in hip joint diseases among children with cerebral palsy for a standard anterior-posterior radiograph based upon AA, RI, GMFCS level and ambulation with a model accuracy 91.1%. The critical level of indicators in which indications for pelvic and proximal femur osteotomy are detected is for AA &gt; 23.55 ̊, for RI &gt; 34%.

Total hip arthroplasty in ankylosing spondylitis in young patients: A prospective study

Background: Ankylosing spondylitis (AS) is a chronic seronegative inflammatory arthritis of unknown etiology characterized by inflammation of joints of the axial skeleton. It primarily affect the spine and pelvis but peripheral arthritis and enthesitis are common features. The mean age of onset of symptoms is between 15 to 25 years and it is more common in males. Severe disability and functional impairment can result rapidly due to a combination of axial spine and hip involvement. When painful degenerative changes occur, Total Hip Arthroplasty (THA) has been shown to alleviate pain and improve function. The aim of this study is to evaluate the clinical, radiological and functional outcome of uncemented THA in young patients of ankylosing spondylitis.Materials and Methods: This prospective study was carried out in 12 male patients of ankylosing spondylitis all aged above 25 years. Uncemented THA was done in all 12 cases of AS. The study was conducted for a period of 12 months and cases were followed up for a period of 6 months. Functional outcome of hip were evaluated using Harris Hip Score (HHS) at regular intervals.Results: 12 young male AS patients were selected for the study and average age of surgery is 36 years. The final functional outcome of hip on the basis of Harris Hip Score(HHS) were 8(67%) patients good result, 3(25%) patients excellent result and 1(8%) patient have shown fair result. Radiological outcome was passed on the basis of Anterior-posterior (AP) radiograph taken immediate postoperatively and then at 1,2,3,6 months. Radiological outcome was satisfactory except in 3 cases where heterotrophic ossification were noticed in AP radiograph later after 6 months of surgery.Conclusion: This study concludes that uncemented Total Hip Arthroplasty (THA) in young patients done for ankylosing spondylitis provide substantial clinical and functional outcome in patients function. The improvement of in functional outcome and quality of life and postoperative reduction of pain have justified the need of THA in these stiff hips in AS.

Özel Radyografi Bulgusu ile Bilateral Triquetrum Kırığı

A 44-year-old male patient presented to the emergency department with pain in both wrists because of falling. It was learned that both wrists of the patient were in dorsiflexion while falling, and there was no additional injury. The Glasgow coma scale score was 15; vital values were within normal limits. The patient had bilateral wrist tenderness, pain with ulnar deviation, and edema on the dorsal side. In addition, he had pain with palpation of the left snuff box. Examinations of the ulnar and radial nerves and arteries were normal. X-rays showed a triquetrum fracture in the right hand, and a triquetrum and scaphoid fracture in the left hand. While triquetrum fractures were not apparent on anterior-posterior radiographs, they were clearly visible on both lateral radiographs (Figure 1). With a short-arm splint for the right hand and a scaphoid cast for the left hand, the patient recovered without sequelae after 6 weeks of wrist immobilization.&#x0D; Triquetrum fractures are generally classified as dorsal cortex fractures and body fractures. Dorsal cortex fractures are more common and are usually seen as avulsion fractures. They occur with trauma, especially in the form of falling with wrist dorsiflexion. Our patient also fell with the same mechanism. To diagnose triquetrum fractures, lateral and oblique radiographs should be performed in addition to anterior-posterior radiographs. In particular, dorsal cortex fractures may not be visible on the anteroposterior radiograph, while the avulsion fragment is better seen on the lateral radiograph. The appearance of triquetral fractures on the lateral radiograph is called the "pooping duck sign" because of the typical shape it forms with the scaphoid and lunate bone (Figure 2). In our case, although both triquetrum fractures could not be clearly seen on the anterior-posterior radiograph, they were seen more clearly with typical findings on the lateral radiograph. Triquetrum fractures are typical of carpal bone fractures, which can be seen more prominently on lateral radiographs, and knowing the specific finding on the lateral radiograph may help with the diagnosis.

Three-Dimensional Functional Impingement in Total Hip Arthroplasty: A Biomechanical Analysis.

Although component offset can affect impingement after total hip arthroplasty, the exact impact is unclear. Evaluation of offset on an anterior-posterior pelvic radiograph is different than evaluation in functional positions of impingement, namely flexion/internal rotation and extension/external rotation. We quantified the effect of acetabular (cup/liner) vs femoral (head/stem) offsets on changes in range of motion to extra-prosthetic impingement in these 2 impingement-prone functional positions. We retrospectively identified 16 total hip arthroplasty patients (age 61.5±12.1 years, body mass index 28.3±4.9 kg/m2) with preoperative and postoperative computerized tomography scans. To eliminate metal artifact, femoral and pelvic 3-dimensional models were created using preoperative scans aligned with postoperative scans, and 3-dimensional scanned implant models were used to reproduce clinical implantation. We tested ±5 mm acetabular cup, acetabular liner, femoral stem, and femoral head offsets. Maximum range of motion (ROM) to bone-bone impingement was calculated for internal rotation at 90° flexion and external rotation at 10° extension. In all cases, increased offset increased ROM to impingement, and vice versa. During internal rotation at 90° flexion, ±5 mm liner offset had the greatest impact on ROM (+9°/-10°), followed by cup (+8°/-9°), head (+5°/-7°), and stem (+3°/-5°) offset. During external rotation at 10° extension, ±5 mm cup offset had the greatest impact on ROM (+10°/-10°), followed by liner (+9°/-9°), head (+7°/-8°), and stem (+4°/-4°) offset. However, no statistically significant differences were found in the changes to ROM in flexion obtained through cup and liner offsets, the changes to ROM in extension obtained through liner and head offsets, and the changes to ROM in extension obtained through increasing stem and head offsets. Increasing offset by any method reduces impingement. Center-of-rotation offset changes via acetabular cup or liner have the greatest impact on extra-prosthetic impingement.

Developmental disorders of the hip treated at the Clinic for Orthopaedic Diseases – in a period of 10 years (2009-2018)

Developmental hip dysplasia includes a wide range of conditions such as subluxation, dislocation, hip instability, and teratological hip. The diagnosis was confirmed by clinical examination, ultrasound examination and anterior-posterior view radiograph (AP). Treatment varied depending on the patient's age and the degree of dysplasia: Pavlik harness, closed reduction, open reduction and corrective osteotomies. In this study 242 patients were included, of whom 198 were female patients and 44 male. All of the patients were treated with conservative treatment- closed reducation and spica casting. Left-sided dislocations were more common than right sided dislocations with predominance in the female patients. The main treatment in follow-up patients was closed reduction with or without adductor muscle tenotomy (m. add. longus). In cases with unsuccessful attempt of closed reduction, open reduction was performed with or without adductor muscle tenotomy. Depending on the residual dysplasia, patients were additionally treated with pelvic osteotomies (Salter 's inominate osteotomy), varus derotation osteotomy, valgus osteotomy, proximal femoral resection, and trochanter major transposition. 167 patients were treated with closed reduction and 3 with open reduction. The remaining patients were treated with closed reduction and additional surgery or with open reduction and additional surgery. Out of all treated patients, only 10 patients had recurrent dislocation of the hip, 7 female and 3 male patients. Closed reduction was performed again on two patients, and open reduction of the hip was performed on one patient. The average age of patients was 21.5 months. By presenting the cases in a period of 10 years, it was conclud that most cases were diagnosed later. Also, the standard closed reduction treatment was successful even after the first year in said patients. Depending on the residual dysplasia of the hip, in order to achieve better congruence of the joint, additional surgeries were performed.

Metabolomics with severity of radiographic knee osteoarthritis and early phase synovitis in middle-aged women from the Iwaki Health Promotion Project: a cross-sectional study

BackgroundOsteoarthritis (OA) is one of the costliest and most disabling forms of arthritis, and it poses a major public health burden; however, its detailed etiology, pathophysiology, and metabolism remain unclear. Therefore, the purpose of this study was to investigate the key plasma metabolites and metabolic pathways, especially focusing on radiographic OA severity and synovitis, from a large sample cohort study.MethodsWe recruited 596 female volunteers who participated in the Iwaki Health Promotion Project in 2017. Standing anterior-posterior radiographs of the knee were classified by the Kellgren-Lawrence (KL) grade. Radiographic OA was defined as a KL grade of ≥ 2. Individual effusion-synovitis was scored according to the Whole-Organ Magnetic Resonance Imaging Scoring System. Blood samples were collected, and metabolites were extracted from the plasma. Metabolome analysis was performed using capillary electrophoresis time-of-flight mass spectrometry. To investigate the relationships among metabolites, the KL grade, and effusion-synovitis scores, partial least squares with rank order of groups (PLS-ROG) analyses were performed.ResultsAmong the 82 metabolites examined in this assay, PLS-ROG analysis identified 42 metabolites that correlated with OA severity. A subsequent metabolite set enrichment analysis using the significant metabolites showed the urea cycle and tricarboxylic acid cycle as key metabolic pathways. Moreover, further PLS-ROG analysis identified cystine (p = 0.009), uric acid (p = 0.024), and tyrosine (p = 0.048) as common metabolites associated with both OA severity and effusion-synovitis. Receiver operating characteristic analyses showed that cystine levels were moderately associated with radiographic OA (p < 0.001, area under the curve 0.714, odds ratio 3.7).ConclusionLarge sample metabolome analyses revealed that cystine, an amino acid associated with antioxidant activity and glutamate homeostasis, might be a potential metabolic biomarker for radiographic osteoarthritis and early phase synovitis.

Clinical and Radiographic Dependences of Functional Status, Indices of the Hip Joint, and Femur Migration in Children with Cerebral Palsy

Relevance: Significant incidence of hip pathology in different groups of children with cerebral palsy and factors that may affect its formation are relevant objects of the study.&#x0D; The Goal of the Study: To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy.&#x0D; Materials and Methods: We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, and statistical analysis of hip parameters and factors that may have influenced their formation. The total number of patients was 47 persons (86 joints).&#x0D; Results: Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history.&#x0D; Conclusions: The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning the patient's body using our own method can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck-shaft angle and torsion of the femur.

Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip?

Background: To analyze the clinical data of patients aged < 6 months with developmental dislocation of the hip (DDH) treated with Pavlik Harness (PH) in order to identify the best time to terminate PH treatment. Method: Fifty-four patients (47 females, 7 males; 63 hips) met the inclusion criteria and were included in the study; there were 33 (61.1%) left, 12 (22.2%) right and 9 (16.7%) bilateral DDH. The mean age at diagnosis was 11.8 ± 5.9 weeks (range, 1.4–25.5). All patients underwent fulltime PH treatment for about three months. At completion of PH treatment, patients were then divided into Group A, including patients with clinically stable hip joint and Graf type-I hip on ultrasound (US), and Group B, including patients with clinically stable hip joint and well-reduced hip on anterior-posterior (AP) radiographs without acetabular dysplasia. Six months after completion of PH treatment, the presence/absence of residual acetabular dysplasia (RAD) was evaluated on AP pelvis radiographs. The t-test and chi-square test were used to compare the differences in age, gender, side, Graf classification and RAD rate between the two groups of patients. Results: At completion of PH treatment, 45 hips were in Group A and 18 in Group B. There were no significant differences in age, gender, side, preoperative alpha angle and Graf classification between the two groups. Six months after discontinuation of PH, the AI in Group A (27.1° ± 6.8°) was significantly higher than that in Group B (21.9° ± 3.5°; p = 0.001); moreover 23 hips (51.1%) in Group A developed RAD compared to one hip in Group B (5.6%; p = 0.001). Among Group A patients, those with RAD were significantly older (13.7 ± 4.9 weeks) than those with normal hips (7.6 ± 3.8 weeks; p < 0.001); the incidence of RAD was significantly lower in patients with Graf type-II D hips (22.2%) than in patients with Graf type-III (70%) and type-IV hips (71.4%; p = 0.006). However, logistic regression analysis identified age as the only risk factor for RAD. All 24 hips with RAD (24/63, 38.1%) were treated with abduction braces. At final follow-up, AI in Group A (20.5° ± 3.3°) was not significantly different from that in Group B (21.9° ± 3.3°; p = 0.132). At the last follow-up visit, five hips (11.1%) in Group A still had RAD, compared to none in Group B (p = 0.31). Conclusions: In patients with DDH treated by PH, Graf type-I on US is not an absolute timing to terminate PH treatment. In addition, patients ≥ 13 weeks had a high risk of RAD despite PH treatment as 51.1% of infants developed RAD during follow up. Follow-up radiographs should be requested in all patients achieving Graf type-I hips at completion of PH treatment.

A New Method for Quantifying 3D Skeletal Morphology in Living Subjects Using Low‐Dose Stereo Radiographs

Accurate and repeatable assessments of three‐dimensional (3D) skeletal morphology are critical to interpretations of vertebrate functional anatomy. In skeletal specimens, these goals can be accomplished using in‐silico models derived from 3D laser scan, photogrammetry, or computed tomography (CT) data. Assessments of skeletal morphology in living subjects, especially humans, are more challenging and are often either cost‐prohibitive (e.g., magnetic resonance) or expose subjects to high doses of ionizing radiation (e.g., CT). Here, we present a new, open‐source method for assessing 3D skeletal morphology using ultra‐low dose biplanar radiographs. Biplanar radiographs were obtained using an EOS Imaging System (EOS Imaging, Inc., Paris, France). A custom‐built calibration frame with radiopaque markers was scanned using this system on multiple days in multiple positions inside the scanning space. We quantified the 3D coordinates of markers by placing landmarks at the center of each marker in both anterior‐posterior and lateral radiographs. Landmark data for each scan were collected independently by two observers to determine inter‐observer error. 3D coordinates of landmarks in each scan differed by &lt;1 mm between observers, suggesting strong repeatability in assessing morphology of living subjects. To assess distortion in EOS images, we constructed a second calibration device, a flat plate with radiopaque markers at the corners of three squares with 10 cm, 20 cm, and 30 cm sides, respectively, surrounding an origin point. The calibration plate was scanned with the origin point at the center of the scan area and the sides of the squares parallel to the detectors. We identified distortion at the edges of EOS images which could significantly impact measurements on skeletal features near the margins of the scan area (i.e., hips, pelvis, lower limbs) and developed a method to mathematically correct for resulting distortion in landmark data. Finally, we demonstrate this method using measurements of iliac blade and spinous process orientation in a sample of living human participants. This method will be applicable to studies of multiple human cohorts, including symptomatic and asymptomatic groups, as well as to other biplanar radiograph platforms and study organisms.

A novel approach to studying early knee osteoarthritis illustrates that bilateral medial tibiofemoral osteoarthritis is a heritable phenotype: an offspring study.

To assess the potential of studying offspring of people with and without knee osteoarthritis to understand the risk factors and heritability for knee osteoarthritis. We selected two groups of Osteoarthritis Initiative (OAI) participants from one clinical site: (1) participants with bilateral radiographic medial tibiofemoral osteoarthritis and (2) those without tibiofemoral osteoarthritis. We then invited biological offspring ≥ 18years old to complete an online survey that inquired about osteoarthritis risk factors and symptoms. Among the survey respondents, we recruited ten offspring of members from each group for a clinic visit with bilateral knee posterior-anterior radiographs and magnetic resonance imaging of the right knee. We established contact with 269/413 (65%) eligible OAI participants. Most (227/269, 84%) had ≥ 1 eligible biological offspring, and 213 (94%) were willing to share information about the new family study with their offspring. Our survey was completed by 188 offspring from 110 OAI participants: mean age of 43.0 (10.4) years, mean body mass index of 23.7 (5.9) kg/m2, 65% female. Offspring obesity (OR = 2.7, 95% CI 1.0-7.3), hypertension (OR = 3.7, 95% CI 1.2-11.3), and Heberden's nodes (OR = 3.6, 95% CI 1.0-13.2) were associated with parental osteoarthritis status; however, adjusted models were not statistically significant. Radiographic tibiofemoral osteoarthritis (16/18 knees vs. 2/20 knees) and meniscal abnormalities (7/9 vs. 2/10 index knees) were more common among offspring with parental osteoarthritis status than not. We established the potential of a novel offspring study design within the OAI, and our results are consistent with bilateral radiographic medial tibiofemoral osteoarthritis being a heritable phenotype of osteoarthritis.

Türk erişkinlerindeki kalça eklem morfolojisinde cinsiyet farklılıkları üzerine radyografik çalışma

Aim: This study aims to determine the gender differences in hip joint functional anthropometric measurement values in Turkish adults.Materials and Methods: Digital pelvis anterior-posterior radiographs of 300 randomly selected patients were analyzed. In these radiographs, reference lines were drawn and femoral neck-shaft angle (NSA), hip rotation center (HRC), abductor moment arm (AMA), body weight moment arm (BMA) were calculated. The relationship of the distribution of measurement results with gender and age was examined.Results: It was determined that the mean NSA scores in men were significantly higher than in women (p&amp;lt;0.05). It was determined that AMA value was significantly higher in men and BMA value was significantly higher in women (p&amp;lt;0.05). BMA/AMA ratio was found to be statistically significantly higher in women (p&amp;lt;0.005).Conclusion: Statistically significant differences were found between men and women in the mean of AMA, BMA and BMA/AMA in the Turkish population.

Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system

PurposeTo evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction.Materials and methodsTwenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19–56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior–posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction.ResultsPostoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8–19.0) to 14.5 ± 3.3 mm (8.7–20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (− 0.4–0.9) to 0.6 ± 0.3 (1.1–0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67).ConclusionsSubstantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way.Level of evidenceIV.

Estimating Tibia Length: An Anatomical Landmarks Evaluation of Bones and X-ray Radiographs

The ability to estimate the length of the bone is a major step towards estimating the stature of an individual in forensic investigation of mass fatalities where body parts are dismembered, scattered and mixed up. This is so because researchers have established that long bone length correlates with stature. Nine parameters of the tibia bone were measured using anthropometric board, anthropometric tape and digital caliper. Five of the nine parameters that could be read on anterior-posterior x-ray radiograph of the tibia measured using a transparent meter rule were used in this study. A total of 600 sample of N = 600, (300 right and 300 left bones) and (320 males: right = 160; left = 160; 280 females: right = 140; left 140 radiographs) obtained from Anatomy museums and hospitals in the six geo-political zones of Nigeria were used in this study. No significant difference (p &lt; 0.05) in the mean value was found between measurements from the bones and those from the anteroposterior x-ray radiographs. The difference in mean for all variables were seen to be significantly (p &lt; 0.05) higher for males compared to females. Results show that the tibia proximal breadth (TPB), medial-lateral diameter at mid-shaft (MLDM) and tibia distal breadth (TDB) were the best predictors of the length of tibia. Thus, in cases of mass fatalities as could happen in a plane crash or bomb blast, the estimate of the fragmented remains of the tibia, when compared with the estimate from an anti-mortem x-ray radiograph, may reveal the identity of the missing individual.

Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases.

It has been proven that a steep tibial slope (TS) is a risk factor for anterior cruciate ligament (ACL) injury and graft insufficiency after ACL reconstruction (ACLR). Recently, there is an increasing number of case series on slope decreasing osteotomies after failed ACLR utilizing different techniques and strategies. Goal of the present study is to report on early experiences with slope decreasing osteotomies in ACL deficient knees with special emphasis on the amount of slope correction, technical details, and complications; and to further analyze differences of slope corrections between sole sagittal as well as combined coronal and sagittal realignment procedures. In addition, we wanted to study if sole sagittal corrections change the coronal alignment. Seventy-six patients with a minimum follow-up of 6 months were identified, who underwent a sole sagittal correction (anterior closed-wedge high tibial osteotomy (ACW-HTO)) or a combined procedure with an additional coronal realignment (medial open-wedge high tibial osteotomy (MOW-HTO)). In ACW-HTO, either infratuberosity or supratuberosity approaches were used. The medial TS was measured on lateral radiographs and the anatomical medial proximal tibial angle (aMPTA) was measured on anterior-posterior radiographs. Technical details and specific complications were recorded. Fifty-eight ACW-HTO and 18 MOW-HTO were performed. Regarding ACW-HTO, an infratuberosity (N = 48) or a supratuberosity (N = 10) approach was chosen. Sixty-seven patients had at least 1 previous ACLR. Mean TS changed from 14.5 ± 2.2° to 6.8 ± 1.9° (P < 0.0001). Mean TS of ACW-HTO was significantly reduced (14.6 ± 2.3° vs. 6.5 ± 1.9°; P < 0.0001), whereas in combined coronal and sagittal realignments, from 14.1 ± 1.9° to 7.6 ± 1.9° (P < 0.0001). The TS reduction in sole sagittal corrections was significantly higher compared to combined procedures (8.1 ± 1.6 vs. 6.4 ± 1.6°; P = 0.0002). Mean aMPTA in ACW-HTO changed from 87.1 ± 2.1° to 87.4 ± 2.8 (n.s.). However, there was a significant inverse correlation between the amount of sagittal correction and coronal alteration (r = -0.29; P = 0.028). There was one late implant infection, which occurred 5.5months after the index surgery. ACW-HTO and MOW-HTO facilitate significant slope reduction with a low-risk profile in patients with ACL insufficiency and a high tibial slope. AOW-HTO does not significantly alter coronal alignment in the majority of patients. IV.

The Ability of Deep Learning Models to Identify Total Hip and Knee Arthroplasty Implant Design From Plain Radiographs.

The surgical management of patients with failed total hip or knee arthroplasty (THA and TKA) necessitates the identification of the implant manufacturer and model. Failure to accurately identify implant design leads to delays in care, increased morbidity, and healthcare costs. The automated identification of implant designs has the potential to assist in the surgical management of patients with failed arthroplasty. This study aimed to develop and validate a convolutional neural network deep learning model for the identification of primary and revision hip and knee total joint arthroplasty designs from plain radiographs. This study trained a convolutional neural network deep learning model to automatically identify 24 THA designs and 14 TKA designs from 11,204 anterior-posterior radiographs obtained from 8,763 patients. From these radiographs, 8,963 radiographs (80%) were used for model training and 2,241 radiographs (20%) were used for model validation. Model performance was assessed through receiver operating curve characteristics. After 1,000 training epochs by the convolutional neural network deep learning model, the computational model discriminated 17 primary THA designs with an area under the receiver operating curve (AUC) of 0.98, sensitivity of 95.8%, and specificity of 98.6%. The deep learning model discriminated eight primary TKA designs with an AUC of 0.97, sensitivity of 94.9%, and specificity of 97.8%. The deep learning model demonstrated an AUC of 0.98 and 0.96 for the identification of seven revision THA and six revision TKA designs, respectively. This study developed and validated a convolutional neural network deep learning model for the identification of hip and knee total joint arthroplasty designs from plain radiographs. The study findings demonstrate excellent accuracy of the deep learning model for the identification of 24 THA and 14 TKA designs, illustrating the great potential of the deep learning model to assist in preoperative surgical planning of failed arthroplasty patients.

Determining the Variation in the Tibial Tuberosity Transposition Distance That Is Required to Correct the Quadriceps Angle With the Severity of Medial Patellar Luxation of the Canine Stifle Joint

The aim of this study was to evaluate the transposition distance in in vitro canine medial patellar luxation (MPL) models of different severity grades using a single radiograph of the stifle joint. Each MPL grade model was generated with manipulation and evaluated by palpating the stability of the patella. An anterior-posterior radiograph of the entire hind limb with extended hip and stifle joints, including the iliopubic eminence, was used for all measurements. The quadriceps angles and the percentage of the transposition distance to the maximum width of the proximal tibia were measured. Our results demonstrated that when the tibial tuberosity transposition procedure is performed in a clinical setting, the required distance to correct the abnormal direction of the extensor mechanism in the canine stifle joint was greater in severe grade MPL than in mild grade MPL.

The discrepancy between radiographically-assessed and self-recognized hallux valgus in a large population-based cohort

BackgroundThere has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration. Knowing this discrepancy will help to make a comparative review of the findings of previous literatures about epidemiological studies about the prevalence of HV.Questions/purposes(1) Is there a discrepancy between radiographically-assessed and self-recognized HV in the general population? (2) What factors affect the self-recognition of HV in the general population?MethodsThe fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1996 participants who had undergone anterior-posterior radiography of bilateral feet and answered a simple dichotomous questionnaire on self-recognition of HV. Measurements of the HV angle (HVA), interphalangeal angle of the hallux (IPA), and intermetatarsal angle between 1st and 2nd metatarsals (IMA) were performed using radiographs. Radiographic diagnosis of HV was done using the definition of hallux valgus angle of 20° or more. After univariate comparison of the participant backgrounds and radiographic measurements between participants with or without self-recognition of HV, multivariable logistic regression analysis was conducted in order to reveal independent factors affecting self-recognition.ResultsSignificant difference was found between the prevalence of radiographically-assessed and self-recognized HV (29.8% vs. 16.5%, p < 0.0001). The prevalence of self-recognized HV increased with the progression of HV severity from a single-digit percentage (normal grade, HVA < 20°) up to 100% (severe grade, HVA ≥ 40°). A multivariable logistic regression analysis demonstrated that HVA, IMA, and female sex were independent positive factors for self-recognition of HV (HVA [per 1° increase]: OR, 1.18; 95% CI, 1.15–1.20; p < 0.0001; IMA [per 1° increase]: OR, 1.15; 95% CI, 1.09–1.20; p < 0.0001; and female sex [vs. male sex]: OR, 3.47; 95% CI, 2.35–5.18; p < 0.0001).ConclusionsThere was a significant discrepancy between radiographically-assessed and self-recognized HV which narrowed with the progressing severity of HV. HVA, IMA, and female sex were independent positive factors for self-recognition of HV. Attention needs to be paid to potentially lowered prevalence of HV in epidemiological studies using self-reporting based on self-recognition.

Clinical Evaluation of the Hip With Focus on Assessment of Hip Instability

Background: Hip instability is a challenging clinical diagnosis, which often overlaps with the presentation of hip impingement and/or hip dysplasia. Many factors contribute to hip instability, including acetabular undercoverage, femoroacetabular-impingement-induced instability, and soft tissue laxity. It can cause significant pain and disability, either as a primary pathology or as a complication of surgery and if untreated can ultimately lead to early osteoarthritis. Indications: Hip dysplasia is often diagnosed with an anterior-posterior pelvic radiograph. The literature has supported a normal lateral center edge angle (LCEA) as ≥25°, borderline dysplasia an LCEA of 18° to 25°, and an LCEA &lt;18° as true dysplasia, though some authors will diagnose borderline dysplasia as an LCEA of 20° to 25° and true dysplasia as an LCEA &lt;20°. In addition, there are many radiographic measurements that have been described to aid in the diagnosis of hip instability beyond LCEA, including the acetabular inclination (or Tönnis angle), the femoro-epiphyseal acetabular roof (FEAR) index, and the cliff sign. Technique Description: Hip instability can be present even in the absence of radiographic findings, and many with insufficient coverage of the femoral head do not meet the radiographic definition of dysplasia. For this reason, it is important to have an understanding of the clinical assessment that may aid in the diagnosis of hip instability. Here, we present our preferred technique for clinical examination of the hip, focusing on the assessment of hip instability. Results: While no one maneuver is sufficient to diagnose hip instability, incorporation of multiple examinations in conjunction with radiographs can help to properly diagnose the presence of hip instability. Discussion/Conclusion: Hip instability is a challenging clinical diagnosis, and many examination maneuvers have been described to assess for hip instability. In this technical note, we describe our preferred technique for clinical examination of the hip, focusing on the assessment of hip instability.

Deep Learning-Generated Radiographic Hip Dysplasia Parameters: Relationship to Postoperative Patient-Reported Outcome Measures

Background: Hip dysplasia (HD) causes accelerated osteoarthrosis of the acetabulum and is diagnosed through radiographic evaluation. An artificial intelligence (AI) program capable of measuring the necessary anatomical landmarks relevant to HD could reduce resource utilization, increase standardized HD screenings, and form HD outcome models. The study’s aim was to evaluate the relationship between AI measurements of dysplastic hips on initial presentation and changes in patient-reported outcome measures following surgical intervention for HD. Methods: One hundred nine patients with HD and planned surgical intervention obtained preoperative anterior-posterior pelvic radiographs which were measured by the HIPPO AI for lateral center edge angle, Tönnis angle, Sharp angle, Caput-Collum-Diaphyseal angle, femoral coverage, femoral extrusion, and pelvic obliquity. Patients completed a preoperative survey containing the 12-Item Short Form, EuroQol Visual Analog Scale (EQVAS), International Hip Outcome Tool (iHOT-12), Harris Hip Score, and Visual Analog Pain Scales. Patients were recommended to follow up at four months and one year to complete the same survey. Changes in outcome measures were evaluated with paired t-tests for each follow-up interval. Partial Spearman Rank-order correlations were performed between radiographic measures and changes in outcome measures at each follow-up interval controlling for age, BMI, and follow-up time. Results: Patients had significant improvement in all outcome measures at four months (N=46, pvalues&lt;0.05) and one year (N=49,p-values&lt;0.001), except one-year EQVAS (p-value=0.090). Significant positive correlation of moderate strength existed between the Sharp angle and iHOT-12 at four months postoperatively (r𝑠=0.472,p-value=0.044). No other significant correlations were found at either follow-up interval between HIPPO measures and outcome measures. Conclusion: Correlations between deep learning radiographic measurements of dysplastic hips and improvements in postoperative outcomes as evaluated by outcome measures lacked any significant relationships in this study. Physicians treating HD patients can augment care with AI tools but outcomes are likely more multi-factorial and require multi-disciplinary patient care.